Does your loved one need help at home,
or are they capable of staying alone?

You should first ask these questions.


Age 60-70 1
71-80 2
81 years and up 3
Hospitalized in the last 12 months? Yes 2
No 1
Mental Ability Forgetful 1
Impulsive 2
Disoriented 3
Walking No Assisitive Devices 0
Cane or Walker 1
Loss of Balance or Weakness? Occasionally 1
Often 2
Fall in last 3 months 3
Steps pose a difficulty? Yes 1
No 0
Medications Currently taking medications that may impair thought processes, cause vertigo, lower blood pressure, or cause central nervous system alterations 1
Laxatives or Diuretics 2
Manage medications without help? Yes 0
No 1
Alone for extended time periods without outside contact? Yes 1
No 0
Manage daily household tasks? Yes 0
No 1
Need help with personal care? Yes 1
No 0
Need someone to drive you places? Yes 1
No 0
Safe alone at home? Yes 0
No 1
(Do you have a med alert button?)

The higher your score tends to be, the more likely that you need help now or will soon need assistance in the future. If you can accomplish most of these tasks on your own congratulations and keep up the good work.